Question

own is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:

Serum glucose 412 mg/dl

Serum sodium (Na⁺) 156 mEq/l

Serum potassium (K⁺) 5.6 mEq/l

Serum chloride (Cl^–) 115 mEq/l

Arterial blood gases (ABGs): pH 7.30; PaCO₂ 32 mmHg; PaO₂ 70 mmHg; HCO₃^– 20 mEq/l

1. What type of water and solute imbalance does Ms. Brown have?
2. What symptoms would you expect to find?
3. What would be the appropriate treatment?
4. What do her ABG results indicate?
5. Does she have an anion gap and what does this indicate?

Answer 1

The patient is having hypertonic imbalance with high solute concentration in the extracellular fluids, which indicates loss of water from the intracellular space, the patient is suffering from hypernatremia (high sodium levels), hyperkalemia (high potassium level) and hyper chloremia (high level of chloride ions), these condition could be due to combination of diabetes and severe coughing, because people with diabetes may urinate excess amount causing dehydration.

ABGs levels indicate that her, Ph is below normal level, so she could be suffering from acidosis, her levels of PACO2 is below normal level so she could be having metabolic disorder and her HCO3 levels is less than 24meq/l so she could be suffering from Uncompensated Metabolic Acidosis.

To caluculate Anion gap [ sodium (156) + potassium (5.6) - [ bicarbonate (20) + chloride (115)] = 26.6 mEq/l. normal serum anion level is around, 8 - 16mEq/l therfore the patient is having positive anion gap, this means she has acidosis associated with an anion other than chloride ion, the reason could be that the patient is diabetic which could have resulted in ketosis (high level of ketone).

Treatment include giving oxygen, and giving insulin and other oral antidaibetic agents to manage her glucose levels, give her nutient supplements,and I.V fluids, and monitor her blood glucose levels..